- Design
- Systematic review and meta-analysis of 39 cohort studies
- Population
- 536,399 childhood, adolescent and young adult cancer survivors and 1.8 million controls
- Primary outcome
- Relative risk of incident cardiovascular disease
- Effect
- RR 1.99 (1.66–2.40); childhood diagnosis RR 2.48 (1.87–3.27)
A JAMA Pediatrics meta-analysis pooled 39 cohort studies comparing 536,399 people who had cancer before age 40 with 1.8 million cancer-free peers.
Survivors had about twice the risk of cardiovascular disease (RR 1.99), equivalent to about 90 extra events per 1,000 survivors. The relative risk was highest when cancer was diagnosed in childhood (RR 2.48) compared with young adulthood (1.61). It fell somewhat with longer follow-up but remained raised more than 20 years after diagnosis, and held across cancer types and in high-quality and population-based studies.
Many survivors are discharged from oncology follow-up into general paediatric or adult primary care, where the cardiovascular legacy of anthracyclines and chest radiation may not be recorded or acted on. These data give a clear reason to keep it on the problem list.
Know which survivors in your care received cardiotoxic treatment, and apply survivorship surveillance guidance for echocardiography and cardiovascular risk factors.
- Record past anthracycline or chest radiation in every childhood cancer survivor's notes
- Follow survivorship guidance on echocardiographic surveillance after cardiotoxic treatment
- Check blood pressure, lipids, glucose and weight in survivors from adolescence onwards
- Advise survivors against smoking and on physical activity as part of routine care
- Include the cancer history in referral letters when survivors transition to adult care
Why it matters
The cardiovascular risk outlasts oncology follow-up, so it falls to whoever sees the survivor next.
Don't overread it
These are pooled cohort associations; individual risk depends heavily on the treatment received.
The statistics, in plain English
An RR of 1.99 means about double the rate; with an interval from 1.66 to 2.40, the true increase is unlikely to be small. The 90 extra events per 1,000 survivors is an average across very different follow-up periods.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for paediatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free